高類胱胺酸血症合併再發性缺血性腦中風：病例報告暨文獻回顧

腦中風一直是高居我國十大死亡原因之一，其主要危險因子除了高齡、高血壓、糖尿病、前次中風、暫時性中風和心臟血管疾病外，一些少見的因素如自體免疫疾病、高類胱胺酸血症（homocysteinemia）亦需考慮。文獻報告指出高類胱胺酸血症是造成身體不同部位血管栓塞的危險因子，包括冠狀動脈、周邊血管及腦血管等。本文報告一高類胱胺酸血症的病例，患者為一位56歲慢性腎功能不足的男性，於民國86年因有三條冠狀動脈狹窄施行血管支架放置術，於民國87年3月及9月有兩次的缺血性中風發作，其中風危險因子包括：高血壓、高血脂、高尿酸、前次中風、心臟血管疾病等，因其多處血管栓塞，且具有慢性腎功能不足病史，高度懷疑尚存其他危險因子，於民國89年7月測其血中類胱胺酸血濃度，發現類胱胺酸血中濃度高出正常人近四倍之多，診斷為高類胱胺酸血症，自此加以治療和追蹤。由於高類胱胺酸血症的症狀不明顯，在診斷上需對此病有所認知，特別注意到此種代謝異常的併發症，高度懷疑下測血中的類胱胺酸（homocysteine）濃度，才能加以診斷和治療。本報告針對高類胱胺酸血症的代謝途徑、原因、致病機轉，以及與各種動靜脈栓塞疾病的關係作文獻回顧。最後，再對高類胱胺酸血症的治療作討論。

關鍵字

高類胱胺酸血症；再發性腦中風；血管栓塞疾病

並列摘要

Cerebrovascular disease (CVD) is a major cause of death in our country. The major risk factors of CVD include old age, hypertension, diabetic mellitus, previous stroke and transient ischemic attack. In recent years, homocysteinemia has been recognized as an independent risk factor of different vascular occlusive diseases, such as CVD and peripheral vascular disease. We reported a 56-year-old man with chronic renal insufficiency who had coronary arterial disease and recurrent ischemic stroke. The risk factors included hypertension, hyperlipidemia, hyperurinemia and previous CVD were identified in this patient. Anticardiolipin antibody and homocysteine were examined in this patient owning to frequent episodes of thrombosis. Homocysteinemia was diagnosed and supplement of vitamin B6, B12 and folate were prescribed. The pathogenesis of homocysteinemia and artherosclerosis were summarized. The relationship of homocysteinemia and thrombotic diseases were also reviewed. Finally, the current therapeutic regimen for homocysteinemia was introduced.

並列關鍵字

homocysteinemia ； recurrent stroke ； vascular thrombotic diseases

國際替代計量

高類胱胺酸血症合併再發性缺血性腦中風：病例報告暨文獻回顧

全文下載

主題瀏覽